CPT code 11302 is for the procedure of shaving a skin lesion that measures between 1.1 and 2.0 cm.
CPT code 11302 is used to describe the procedure of shaving a skin lesion that measures between 1.1 and 2.0 centimeters. This code is specifically utilized when a healthcare provider removes a lesion by shaving it off the skin, rather than excising it completely. This method is often chosen for lesions that are raised above the skin surface and can be removed without cutting into the deeper layers of the skin.
When using CPT code 11302 for the procedure of shaving a skin lesion measuring 1.1-2.0 cm, the following modifiers may be applicable:
1. Modifier 25: Significant, separately identifiable evaluation and management (E/M) service by the same physician on the same day of the procedure or other service. Use this modifier if an E/M service was provided in addition to the shave procedure.
2. Modifier 59: Distinct procedural service. This modifier is used to indicate that the shave procedure was distinct or independent from other services performed on the same day.
3. Modifier 76: Repeat procedure or service by the same physician or other qualified health care professional. Use this modifier if the same procedure was repeated on the same day.
4. Modifier 77: Repeat procedure by another physician or other qualified health care professional. This modifier is used if the procedure was repeated on the same day by a different provider.
5. Modifier 78: Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period. This modifier is used if the patient needs to return for a related procedure within the postoperative period.
6. Modifier 79: Unrelated procedure or service by the same physician during the postoperative period. Use this modifier if the shave procedure is performed during the postoperative period of another, unrelated procedure.
7. Modifier 58: Staged or related procedure or service by the same physician during the postoperative period. This modifier is used if the shave procedure is planned or anticipated as part of the treatment during the postoperative period of another procedure.
8. Modifier 51: Multiple procedures. This modifier is used when multiple procedures are performed during the same session.
9. Modifier 22: Increased procedural services. Use this modifier if the shave procedure required significantly more effort than usual.
10. Modifier 24: Unrelated evaluation and management service by the same physician during a postoperative period. This modifier is used if an E/M service is provided during the postoperative period of another procedure and is unrelated to the original procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement.
The CPT code 11302, which involves a specific medical procedure, is reimbursed by Medicare. Reimbursement for this code is determined based on the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services provided to Medicare beneficiaries.
Additionally, the reimbursement process is managed by Medicare Administrative Contractors (MACs), who are responsible for processing claims and ensuring compliance with Medicare policies.
Therefore, if you perform a procedure associated with CPT code 11302, you can expect Medicare to provide reimbursement according to the rates specified in the MPFS, subject to the guidelines and determinations made by the relevant MAC.
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